Optimizing the Implementation of a Lifestyle Dementia Prevention Intervention for Older Patients in an Academic Healthcare System

Article type: Research Article

Authors: Mace, Ryan A.^{a; b; *} | Lyons, Christopher^a | Cohen, Joshua E.^a | Ritchie, Christine^{b; c} | Bartels, Stephen^{b; c; d} | Okereke, Olivia I.^{e; f; g} | Hoeppner, Bettina B.^{b; h} | Brewer, Judson A.^{i; j} | Vranceanu, Ana-Maria^{a; b}

Affiliations: [a] Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA | [b] Harvard Medical School, Boston, MA, USA | [c] Mongan Institute Center for Aging and Serious Illness, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA | [d] Department of Medicine, Massachusetts General Hospital, Boston, MA, USA | [e] Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA | [f] Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA | [g] Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA | [h] Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA | [i] Mindfulness Center, Brown University School of Public Health, Providence, RI, USA | [j] Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

Correspondence: [*] Correspondence to: Ryan Mace, PhD, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA 02114, USA. E-mail: [email protected].

Abstract: Background:Interventions that promote healthy lifestyles are critical for the prevention of Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD). However, knowledge of the best practices for implementing AD/ADRD prevention in healthcare settings remains limited. Objective:We aimed to qualitatively identify barriers and facilitators to implementing a clinical trial of a novel lifestyle intervention (My Healthy Brain) in our medical center for older patients with subjective cognitive decline who are at-risk for AD/ADRD. Methods:We conducted focus groups with 26 healthcare professionals (e.g., physicians, psychology, nursing) from 5 clinics that treat older patients (e.g., memory care, psychiatry). Our qualitative analysis integrated two implementation frameworks to systematically capture barriers and facilitators to AD/ADRD prevention (Consolidated Framework for Implementation Science Research) that impact implementation outcomes of acceptability, appropriateness, and feasibility (Proctor’s framework). Results:We found widespread support for an RCT of My Healthy Brain and AD/ADRD prevention. Participants identified barriers related to patients (stigma, technological skills), providers (dismissiveness of “worried well,” doubting capacity for behavior change), clinics (limited time and resources), and the larger healthcare system (underemphasis on prevention). Implementation strategies guided by Expert Recommendations for Implementing Change (ERIC) included: developing tailored materials, training staff, obtaining buy-in from leadership, addressing stigmatized language and practices, identifying “champions,” and integrating with workflows and resources. Conclusions:The results will inform our recruitment, enrollment, and retention procedures to implement the first randomized clinical trial of My Healthy Brain. Our study provides a blueprint for addressing multi-level barriers to the implementation of AD/ADRD prevention for older patients in medical settings.

Keywords: Alzheimer’s disease, brain health, dementia, implementation, prevention, qualitative

DOI: 10.3233/JAD-240365

Journal: Journal of Alzheimer's Disease, vol. Pre-press, no. Pre-press, pp. 1-23, 2024